Have I missed something with this customer?

[hip chic]

I have a customer who has been wearing the same pair of glasses for over 5 years (purchased elsewhere). She recently had an eye exam and the Dr. did not change the prescription (she presented both her current and her prior prescription dated 1999). Her prescription is:

OD) -6.50 -3.25 x 110
OS) -7.25 -2.25 x 43

I took her monocular pd, it is 29/30.5

Her prior pair of glasses are 1.67 index.

I made her new specs in 1.7 index (hoya).

My customer picked up her new specs about 10 days ago and came in last night complaining that her left eye socket occassionally aches. She said that on some days, she feels great and sees great and yet on other days, the area around her left eye can ache (either a dull ache or much more severe). She said that when her eye is aching, if she puts on her prior pair of glasses, the ache goes away within 10 minutes.

She also complains that when she closes her left eye and moves her head from side to side, she has no problem seeing through her right eye. On the other hand, when she tries to do the same with her left eye, she feels that she cannot see through the periphery of the left lens. In her prior pair of glasses, she doesn't notice this.


I have compared PDs in her old and new specs. The PD in the left eye (new specs) is 30.5 compared to 31 in old specs.

The vertex distance is equal between her old and new specs.

Parabolic curve, panoscopic tilt equal.

Base curves equal.

Her old specs were metal with a strap bridge and so fit low on her face. Her new specs have nose pads...they also sit low but, it is only slight and she is looking more through the center of the lens than the upper quadrant (by about 2.5 mm). She also "complains" that her distance vision (i.e. while driving) is fantastic...much better in her new specs...while reading and intermediate vision is not as good in her new specs. I attribute this to the fit of the specs as described above. (Please note: she wears a seperate pair of specs for extended reading)


Honestly, I feel I have checked everything on these specs. I think I have told you all of the variables between her old and new specs...soooo...Have I missed something with this customer?

Thanks for your help,
hip chic

[Judy Canty]

Is age a factor? Perhaps an emerging presbyope? Can her prescribing dr. provide you with an over-refraction?

[chip anderson]

What were her old lenses made of?

[QDO1]

The old ones could be a bit minus and the new ones a bit too plus?

The new ones could be surfaced poorly - waves etc.

The coating could be faulty

[Happylady]

Since it is just the left lens could it be a surface problem with the lens? If it is a Hoya lens with Super Hi Vision doesn't it have a unlimited scratch warranty?

Could you send it back under the scratch warranty and have it redone and see if it is better?

[hip chic]

Thanks for all of your comments so far.

I do not detect any kind of wave in the left lens. I am getting very clear readings in my lensometer...I suppose it's a possibility that there is a wave that I'm not seeing? Can someone make comment about that possibility?

Regarding a coating issue...is this something I would be able to see myself? Or is it something that only the wearer would notice?

This customers old lenses were a 1.67 (I don't know the manufacturer...she didn't get them here). Her new lenses are a Hoya 1.70

I would estimate that this customer is about 60 years old. She IS a presbyope. I think she commented that she has unsuccessfully tried bifocals in the past. Therefor, she has two pair of specs, one for distance and one for near (same frame, same lens index etc. etc. ...both about 5 years old).

Again, thanks for helping.
hip chic

[hip chic]

Oh, and I forgot to address the comment that perhaps the old lenses are a bit too minus and the new a bit too plus. I do not have to touch the power wheel when I compare the two sets of lenses...see what I mean? It seems that this is not an obvious, usual troubleshooting situation.


hip chic

[Happylady]

Does it have an unlimited scratch warranty? If so send it back. Sometimes lenses look perfect but have defects that won't get picked up on a lensometer.

[Jedi]

Does it have an unlimited scratch warranty? If so send it back. Sometimes lenses look perfect but have defects that won't get picked up on a lensometer.

I hope your joking because I have some issues with your statement. Sending a job back because it "might" have some invisible problem with it, is not trouble-shooting at all, it's ineffective and lazy. What happens when it comes backs with the same problem 2 weeks later. Your client is out their time and without eyewear that works. Your lab eats a set a lenses that should never have been made. This type of practice in the long term will cause prices to go up, discounts to be reduced and warranties to become more strict.

Hip-chic- Are both lenses aspheric? In the past I've had clients who couldn't tolerate a change from 1.67 to 1.74 (identical frames and RX's).

[Happylady]

No, I am not joking. He stated that when the woman tried to look out of the periphery of her left lens it was blurry and she couldn't see. It sounds to me that there is a defect in that lens. If he would perfer he could call the lab and state the problem with the lens and ask them to look at it and remake it as defective.

[Jedi]

If he would perfer he could call the lab and state the problem with the lens and ask them to look at it and remake it as defective.

That is reasonable when you have exhausted your capabilities in the office, or need a set of fresh eyes, but both your posts appeared to recommend sending it back under a scratch warranty (presumably by scratching or crazing it in-office) when that is not the problem.

[C-10]

have you rechecked the Rx in the left eye and how much of a change is there in the left eye.

[Happylady]

When I have had problems with lenses and couldn't find anything wrong I would discuss it with the lab. I have openly told them I was going to return it under the scratch warranty and they have had no problem with it.

[GOS_Queen]

You mentioned that the dr didn't change the Rx ... that she brought a copy of the old Rx from 1999 with her ... but what is the actual Rx she is wearing ? I'm wondering with that cyl if there could be an axis difference (perhaps what was made is not what was prescribed)

Karen

[Clive Noble]

Maybe I missed it, but are the optical centres higher or lower in the new specs? Possibly they were too low in the old ones and the Pt has got used to the visual effect and now that they are possibly at a better height he notices the difference even though they are more correct

I'm having terrible probs with a Pt, similar Rx, who has been wearing his old scratched hi index lenses for 6 years, about 3 years ago the frame broke, he was in the Far East at the time and an optician transferred them to a new frame and instead of his 64mm ocs he now has 68. He did say it took a few days to get used to the new frame.

We remade the lenses last month, same Rx with his original PD and he can't get on with them, headaches, pulling of the eyes etc.... when I put a 3^ prism before him, everything became clear and calm (in his words)
He does understand the problem.
I've told him to try and get used to the real PD, if not, we'll change one lens and push the centre out.

[QDO1]

Sometimes if there is a change in frame size or shape the patient cant cope with the new presentation of the image, this is especially true when the script is astigmatic high minus, and the new frame is wider. The extra information from the edge of the lens is seen as blur, and fringing TCA and all that, that extra information enters the eye, and can upset the rest of the field of view

Incidently - are the edges finished the same - supra, full rimmed, polished, mattte?

[hip chic]

I'll try and answer all of your questions...

The lenses are the exact same prescription...they were prescribed that way and they check out in my lensometer as being identical prescriptions.

Clive...I think you are thinking the same thing I am...the customer is looking about 2.5 mm closer to the optical center (through her new glasses than through her old). Her old specs were metal with a strap bridge and sat low on her face. I was thinking that this might explain why she feels her distance vision is much better with her new specs. It's the "eye socket pain" in the left eye that I don't have an explanation for...and on some days but, not others? This sounds to me like something other than the glasses.

Her new lenses are about 2mm larger (per eye) than her old which would account for more blurring at the periphery...however she only notices it on the left eye. This could prove my observation in the past few years that some people seem to have more of a sensitivity on one eye than the other. Or are more sensitive, in general, on one side of their bodies (ears included) than others...has anyone else ever thought this?

Jedi...I agree with you that I'll do my best troubleshooting before I ship the specs back for a new left lens. I don't feel that waves and defects (at least from my top notch lab) are common and therefor, I don't want to just jump to that conclusion.

Both pair of specs are aspheric.

Thanks again...
hipchic

[drk]

Note, first, that this lady is anisometropic. The vertical meridian OD is around -6.25 and OS is around -8.25. Note that the vertical OC is critical, here. This also explains her inability to wear multifocals.

You have more properly centered her with your level MRP. If she has MRPs too low in her old frame, she is (inadvertently) looking through 2D x 0.2cm= 1/2^ BU OS. You have removed this prism.

Is 1/2^ that big a deal? I doubt it, but it is possible to explain the symptoms this way. What if she is slightly left hypophoric to begin with?

I'd do these things:
1.) Trial about 1^ BU OS over the new Rx and see if she gives some super-relieved response. If so, you add prism.

2.) Ask the prescribing Dr. if he has vertical phoria data (which I'm sure he won't). If there is a vertical phoria, see if it's a left hypo.


Another theory: Nosepad pressure. Can you temporarily strap-bridge her new ones?

Another theory: It's unrelated to the glasses, despite her old glasses' palliative response. Let's face it: what strictly optical problem causes moderate to severe headaches?

Things that I can't explain:
1.) She has more peripheral blur with the 1.7's OS than with the 1.67. Why? Different aspheric properties between lens designs?

2.) She likes her DVA better with the 1.7's than with the 1.67's? And, apparently, it seems "more minus" to her, since her intermediate and near acuity seems lesser? All this in the same exact Rx? Again, differences in aspheric designs? Maybe a new theory could be a shorter vertex with the new frames? Try increasing vertex distance on the new pair and see if she likes it.


Please post your findings!

[Ed_Optician]

Is there a difference in BC? Is there a difference in vertex distance? The change of lens material will change the ocular surface curves possibly by .50D I didnt run it in RXP to see the surface curves. Make sure frame has similar pantoscopic tilt, face form and vertex distace. Mark up both pair with OC height and compare to pupil height

Try all of this you might get lucky figuring out what factr is amiss

Ed

[Robert Martellaro]

You have more properly centered her with your level MRP. If she has MRPs too low in her old frame, she is (inadvertently) looking through 2D x 0.2cm= 1/2^ BU OS. You have removed this prism.

Is 1/2^ that big a deal? I doubt it, but it is possible to explain the symptoms this way. What if she is slightly left hypophoric to begin with?

I'd do these things:
1.) Trial about 1^ BU OS over the new Rx and see if she gives some super-relieved response. If so, you add prism.

2.) Ask the prescribing Dr. if he has vertical phoria data (which I'm sure he won't). If there is a vertical phoria, see if it's a left hypo.

Bingo! Induced vertical phoria, and I'd bet it's more than .5^ because there's probably very little panto if the glasses are sitting low, otherwise the cheek would get in the way.

She likes her DVA better with the 1.7's than with the 1.67's? And, apparently, it seems "more minus" to her, since her intermediate and near acuity seems lesser? All this in the same exact Rx? Again, differences in aspheric designs? Maybe a new theory could be a shorter vertex with the new frames? Try increasing vertex distance on the new pair and see if she likes it.

Martin's rule might explain the near point...induced plus cyl (I believe it's plus if too low) from the insufficient panto/low OC (get some of this back by cutting the distance .25DS?), and the distance VA improvement is probably due to the decrease from the induced Trans Chromatic Aberration with 1.70's higher Abbe value, or from both of the above.

Regards,

[drk]

Nice!

[Clive Noble]

Nice explanations here...... I'm being a bit cynical and sticking my neck out here, but if you say to the Pt "OK I'll remake the lenses and get the horizontal and vertical centres as old"........ I wonder if she'll say
"In that case, how about a different frame?"

We've had many cases where the Pt has made up all sorts of stories just to get a change of frame

[Susan]

Just a thought could her new frame with nose pads be causing a slight dry eye from resting on her sinus?:idea:

[Andrew Weiss]

You have more properly centered her with your level MRP. If she has MRPs too low in her old frame, she is (inadvertently) looking through 2D x 0.2cm= 1/2^ BU OS. You have removed this prism.

Is 1/2^ that big a deal? I doubt it, but it is possible to explain the symptoms this way.

Might the size of the "fitting button" on the two different lenses exacerbate the perceived prism effect? or the curve structures of the differing aspheric lens designs? This is hard to check for. If I remember correctly, some aspheric designs "terrace" and others use smoother, more incremental, gradations.

This thread is being a great learning experience!

[hip chic]

I wanted to update all of you on this customer. But first I think I should back up and tell you "the rest of the story". When this customer first came in to my shop several months ago, she said that she had a "phobia" of people in the optical business because she had never gotten a pair of glasses "trouble free". She made three trips to my shop before she even tried a pair of glasses on. She would only look at frames and sort of size me up, I guess. She finally placed an order. Because of her phobia and all the trouble she's had in the past, I was careful to do absolutely everything I could to make a perfect pair of glasses for her...and then to adjust them (matching the adjustments to her old pair of glasses) as best I could.

Last week when she came in (nearly 10 days after picking up her new specs...where the adjustment had taken over an hour) she made the complaints I wrote you about. In rechecking everything again, I noticed that the left eyewire was slightly twisted causing a change in axis of 1/2 to 1 degree...I realigned it. She felt it may have helped a little but, had not completely solved her problem. Because I felt I'd been so careful in making everything as perfect as possible with her new specs, I told her that I just wasn't sure what else I could do for her. But, I told her I would ask here (Optiboard) to be sure I hadn't missed anything. She said that she really loved the way the glasses looked and didn't want to return them.

Again, this is when I originally posted on Optiboard. I didn't want to post about the customers feelings about people in our profession because I really wanted to entertain the thought that there could be something wrong with her specs (I didn't want to brush it off as "in her head" and I didn't want you to either).

Now the update...my customer called me a day later to say that everything seemed great. And then 2 days after that, she said the same thing. And I received an e-mail this morning saying that still all is fantastic with her specs.

Whether it was the 1/2 to 1 degree rotation I made, the subtle suggestion of a possible return/refund of her specs along with the words "I'm not sure what else I can do to make these better" or whether it just took this amount of time to get used to the specs...who knows....but, I appreciate the time and effort you all put in to helping me.

I loved this thread...so detailed...so analytical...I really did learn something...that's what I LOVE about this business...after 24 years, I'm still learning.

Thanks again,
hip chic